Reduced dopaminergic tone in hypothalamic neural circuits: expression of a "thrifty" genotype underlying the metabolic syndrome?

The thrifty genotype hypothesis postulates that the genetically determined ability to grow obese and insulin resistant in times of food abundance confers a survival advantage in times of famine. Obviously, this ability poses a major health threat in modem times, where food is always available in large quantities. In the last 10-15 years, many genes encoding. pathways that orchestrate energy balance and fuel flux have been discovered. This paper summarizes the evidence that diminished dopaminergic tone in hypothalamic nuclei contributes to the "thrifty" genotype/phenotype. Reduced dopaminergic neurotransmission in the suprachiasmatic nucleus of seasonally obese animals appears to drive noradrenalin and NPY mediated transmissions in other nuclei to induce the obesity syndrome at the appropriate time of year. Treatment with dopamine D-2 receptor agonists can fully reverse the metabolic syndrome in these animals. Similar mechanisms are operative in non-seasonal obese animal models. In man, treatment with dopamine D-2 receptor antagonists induces obesity and type 2 diabetes mellitus, whereas dopamine D-2 receptor activation ameliorates the metabolic profile in obese nondiabetic and diabetic humans. Various loss of function mutations of the dopamine D-2 receptor gene are associated with overweight in humans. In concert, the data support the notion that diminution of dopaminergic (dopamine D-2 receptor mediated) transmission in relevant hypothalamic nuclei sets the stage for efficient partitioning of ingested nutrients to contribute to a phenotype that is not so thrifty anymore. (C) 2003 Elsevier B.V. All rights reserved.